Provider Demographics
NPI:1619247269
Name:DARRYL K. WARNER
Entity Type:Organization
Organization Name:DARRYL K. WARNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:KEEF
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-623-5592
Mailing Address - Street 1:201 HOSPITAL DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-7019
Mailing Address - Country:US
Mailing Address - Phone:814-623-5592
Mailing Address - Fax:814-623-2249
Practice Address - Street 1:201 HOSPITAL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7019
Practice Address - Country:US
Practice Address - Phone:814-623-5592
Practice Address - Fax:814-623-2249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004738L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012378660004Medicaid